ISSN 2398-2977      

Gastrointestinal: clostridiosis

pequis
Contributor(s):

Prof Jonathon Naylor

Synonym(s): Clostridial enterocolitis


Introduction

  • Intestinal clostridiosis is a bacterial Clostridium perfringens infection which commonly causes severe diarrhea.
  • Cause:Clostridium perfringenstype A. Possible causes include: types B and C, Clostridium difficile Clostridia sppC. cadaveris or C. sordell. These bacteria are ubiquitous and therefore there must be an inciting cause.
  • Signs: severe and profuse watery diarrhea. Sudden death may also occur.
  • Diagnosis: is extremely difficult.
  • Treatment: relies on supportive therapy as well as antibiotics.
  • Prognosis: guarded to poor.

Pathogenesis

Etiology

Predisposing factors

General

  • Recent antibiotic therapy can predispose to this disease.
  • Foals <5 days old are most susceptible, having least resistance.

Pathophysiology

  • Pathogenicity depends on production of enterotoxins.
  • Clostridial infection of the small and large intestines → severe damage to the bowel walls.
  • Leakage of fluid and electrolytes, and exudation of proteins occur into the bowel lumen, and absorption processes are decreased → diarrhea.
  • Increased bowel permeability facilitates the movement of gut bacteria and toxins into the blood stream → endotoxemia and septicemia.
  • Diarrhea, with endotoxemia and dehydration is the most common sequel, this can → death.
  • Insult allows Clostridium bacteria, normally localized to lower GI tract and in small numbers, to proliferate and produce increased amounts of enterotoxin, especially in the large intestine.
  • The large intestinal disease attributed to C. perfringens type A is manifested by hemorrhagic/necrotizing typhlocolitis.
  • Raised levels of inflammatory mediators such as prostaglandins, prostacycline and leukotrienes result in further inflammation of bowel wall.
  • Stimulation of fluid and electrolyte secretion and protein exudation into bowel lumen results.
  • This, together with decreased reabsorption of fluid, results in diarrhea, and, among other things, hypoproteinemia, hypoalbuminemia (protein-losing enteropathy) and hypokalemia.
  • Increased permeability of intestinal microvasculature also results leading to endotoxemia Endotoxemia: overview.

Timecourse

  • Disease can occur within 3-4 days of initiating antibiotics; or other inciting cause.
  • Progression of disease is extremely rapid.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • South V (2014) Clostridial diseases of the horse. In Pract 36 (1), 27-33 VetMedResource.
  • Divers T J & Ball M (1996) Medical treatment of acute enterocolitis in the mature horse. Equine Vet Educ (4), 204-207 VetMedResource.
  • Wernery U, Nothelfer H B, Bohnel H & Collins W R (1996) Equine intestinal clostridiosis in a group of polo ponies in Dubai, UAE. Berl Munch Tiersrztl Wochenschr 109 (1), 10-13 PubMed.

Other sources of information

  • Rose R J & Hodgson D R (1993) Manual of Equine Practice. Saunders. ISBN 0 7216 3739 6.

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